services for adults with autism
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Services For Adults With Autism. Brian McClean Brothers Of Charity Roscommon. What is it about the classroom that prepares us for life?. What’s important ?. I’ll say it in the most straight-forward way I can: most of the people supported by our human services organi sa tions are lonely. - PowerPoint PPT PresentationTRANSCRIPT
Services For Adults With Autism
Brian McClean
Brothers Of Charity Roscommon
What is it about the classroom that prepares us for life?
What’s important?
I’ll say it in the most straight-forward way I
can: most of the people supported by ourhuman services organisations are lonely.Profoundly lonely. And most of what we doin human services is secondary to helpingpeople form and maintain meaningfulrelationships.
There. I’ve said it. The cat is out of the bag. I
don’t think our industry —and that’s what it
is, an industry — is paying enough attention
to the impact of loneliness in the lives ofpeople who experience disabilities.
I’ll go further. I think most (though not all) of our paperwork, rules, regulations,professional standards, buildings, cell phones, pagers, computer systems, medicines, expertise, science — most (not all) of it is a waste of time and resources. Most (not all) is a physical manifestation of our inability to come to grips with the central issue in peoples’ lives — loneliness.
David Pitonyak, Toolbox for Change
Social Role Valorisation
• Raise consciousness
• Challenge perceptions
• Provide valued social roles
• Promote social inclusionWolf Wolfensburger 1934 - 2011
Challenging Behaviour Is Not The Problem...
...But A Symptom Of The Problem
FIVE STEPS IN BEHAVIOUR SUPPORT
Low ArousalRapport BuildingPredictabilityCommunicationIncentives
Aidan
Brendan
Cormac
Darragh
Nu
mb
er o
f In
cid
ents
0
2
4
6
8
10
12
14
16
18
20
1 3 5 7 9 11 13 15 17 19 21 23 28 44 52 60 68 76 104 156
Aggression
SIB
A B
0
5
10
15
20
25
30
35
1 3 5 7 9 11 13 15 17 19 21 23 28 44 52 60 68 76 104 156
Aggression
Grabs
0
5
10
15
20
25
30
35
40
45
1 3 5 7 9 11 13 15 17 19 21 23 28 44 52 60 68 76 104 156
Aggression
SIB
B+C
B+
C +
D +E
B+C+D
B+C +D +E+F
0
5
10
15
20
25
30
35
1 3 5 7 9 11 13 15 17 19 21 23 28 44 52 60 68 76 104 156
Aggression
Handbiting
A = Baseline B = Low ArousalC = Rapport BuildingD = Visual SequencingE = Escape Communication TrainingF = Differential Reinforcement
Weeks
An Evaluation of an Intervention Sequence Outline in Positive Behaviour Support for People with Autism and Severe Escape-Motivated Challenging Behaviour
McClean and Grey, 2012 Journal of Intellectual and Developmental Disabilities
A Sense Of Home
• Shelter
• Hearth
• Heart
• Privacy
• Identity
• Abode
• Paradise
Looking for a change (n = 46)
0
5
10
15
20
B&B Familyhome
GroupHouse
LargeGroupHouse
LargeCampus
SingleOccupancyOwn Home
DoubleOccupancyOwn Home
ThreePerson
Occupancy
HouseShare
FamilyShare
AnnexApartment
Vision based planning
Every person should have a vision statement of what is
Important to him or her…Important for him or her…And a circle of support
able to speak from a position of love and concern
The life of my choosing (n = 46)
0
5
10
15
20
B&B Familyhome
GroupHouse
LargeGroupHouse
LargeCampus
SingleOccupancyOwn Home
DoubleOccupancyOwn Home
ThreePerson
Occupancy
HouseShare
FamilyShare
AnnexApartment
Starting Visioned
Supported Living Options
Supported living
Remote supervision
Professional family share
House mate
Adjacent housing
“Dublin in the ‘70s”, by John Caslin
“The Job Coach”, Athlone 2005 by John Caslin
St Brendan’s Hospital, Grangegorman
John at Home
John’s Organic Garden
People in family homes or supported living experienced better outcomes:
• better health and well being• greater levels of safety• better personal satisfaction• more use of community facilities, • more friends, • greater autonomy
even when you control for levels of independence
1. Group Homes Don’t Work
The Cost of Person Centredness
Additional cost of vision over Jan 2009 service: €4,654 per person (n = 46)
Exclude four people
needing new high support services:
- €1,158 per person (n = 42) €0
€10,000
€20,000
€30,000
€40,000
€50,000
€60,000
€70,000
Mea
n An
nual
Cos
t.
GroupHome
LargeResidential
Family SupportedLiving
2. Know Your Individual Costs
Individual Costing
Shared by MonthlyHours
Annual Costs
Day Service 4 40 €12,480
Residential 3 55 €17,875
Sunday 3 10 €6,370
Outreach 3 0 0
Sleepovers 3 8 €5,200
Total €41,925
•Number of Days in a 28 Period•Actual Number of Hours per Period•Number of Staff per Period•Total Staff Hours •Number of People Sharing Staff Allocation•Individual Hours•Cost per hour for support type•Annual = 13 Periods of 28 Days
January 2009 – Small group home March 2010 – Supported living
Shared by MonthlyHours
Annual Costs
Day Service 3 53 €16,536
Residential 1 5 €1,625
Sunday 1 0 0
Outreach 2 20 €6,240
Sleepovers 0 0 0
Total €24,401
3. Not All Services Are Effective
Mover (N = 20)
Mean
Non Mover (N = 22)Mean
F df1 df2 Sig
Adaptive Behaviour Scales – Support Needs
132.5 94.0 21.6 1 40 .000
Autonomy 9.6 5.2 10.5 1 40 .002
Mental Health (HONOS) 8.5 15.5 10.1 1 40 .003
Adaptive Behaviour Scales – Challenging Behaviour
44.6 38.3 4.8 1 40 .034
Year of Birth 1973 1970 1.0 1 40 N.S.
Acceptability of the Vision Statement
57.7 53.5 7.7 1 40 .008
Working Alliance Inventory 66.6 58.5 26.4 1 40 .000
Acceptance of Risk -Taking 15.2 13.3 5.5 1 40 .024
Additional Cost Of Vision (€56) €10,813 3.6 1 40 N.S.
Empowerment Instrument 95.5 92.4 2.8 1 40 N.S.
Role Clarity 87.1 85.5 0.4 1 40 N.S.
Standards 21.4 20.2 2.5 1 40 N.S.
Structure 31.2 29.0 4.9 1 40 N.S.
Conflict 13.5 12.7 2.4 1 40 N.S.
Responsibility 25.6 24.9 0.6 1 40 N.S.
Warmth 19.4 18.5 1.4 1 40 N.S.
Ability to express 3.8 4.2 0.1 1 40 N.S.
79% of the variance is explained
Adaptive Behaviour Scale -Support Needs
Working Alliance
Unexplained
Variable Entered into the Equation -2 Log likelihood
Cox & Snell R2
Nagelkerke R2
Adaptive Behaviour Scales – Support Needs 39.33 .361 .48
Working Alliance Inventory 20.28 .594 .79
4. Form A Working Alliance
The extent to which frontline staff and family members – agree about the goals– share a mutual respect and
trust – have a common
appreciation of the person
The heart of the matter
“In the work of change there may be an assumption by the helper that the individual will ... adapt to the helper’s idea of overall objectives, goals and tasks. The working alliance is much more dynamic and mutual, in which there is ongoing dialogue, checking and negotiation about objectives, goals and tasks.
The heart of the matter This is not just a superficial
understanding and negotiation towards a quick consensus. At a deeper level, the working alliance taps into fundamental dilemmas of human existence, such as the negotiation of one’s most important desires with those of another; ...the tension between the need for self – determination and relationship.’’
(Safran & Muran, 2000)